At surface level, medical coding seems simple enough: specific numeric values are applied to all medical diagnoses, symptoms, procedures, drug reactions, procedures and other medical services and events. However, coding is a far more complex maze of proceedure than most would hope. Given that physician reimbursement, hospital payments, quality review, the collection of medical data and many other industry processes are wholly reliant upon proper coding, accuracy is paramount.
Problems That Can Arise As The Result Of Bad Coding
When procedure and diagnostic codes are mismatched, payors are able to deny claims due to lack of medical necessity. Moreover, when mismatched codes are identified by insurance companies, these entities become more likely to closely review all former and future submissions in order to identify other coding issues. When there are multiple instances of mismatched codes, legal action can be taken. This is of particular interest to those who receive reimbursement from Medicare and/or Medicare. Often, physicians will find themselves being audited because of suspected fraud, but it most often is due to bad medical coding.
Bad Coding And Medicare
Medicare can and will deny claims if ICD codes, which have three to five digits, are not written out to full specificity. This means that when five digits are required in order to accurately describe a patient’s diagnosis, it is essential that all five of these digits be used. Down-coding can be viewed by Medicare as a sign of fraud. As result, even when medical providers accept less money than they are entitled to as the result of coding errors, legal action can still be taken. Having the most up-to-date medical coders in the industry, PDN also offers audits for medical coding. Avoid a RAC audit, let us complete your Medicare medical coding.
The Introduction Of Errors
There are a number of areas in which assumptions are made too frequently and in which coders are simply not prudent enough. As coders grow comfortable in their routines, they may become likely to refer to software programs and reference books for help or to dig deeply into medical records in order to verify that their code choices are accurate. Moreover when coders feel pressured to meet production deadlines, many turn away from official coding sources and begin using resources with far less authority.
Distractions In The Medical Setting
Among the most common causes of inaccuracy in medical coding are the numerous distractions that exist in the medical environment. In many settings, medical coders are conducting their work along with other job duties. Opting to outsource these efforts is a great way to ensure that distractions, careless work habits and other issues do not degrade the accuracy of coding results. It can also help practices avoid the many legal and financial issues that these mistakes often cause.